Adoption Application

Adoption Application

You must be 18 or older to adopt a pet
General Information
Full Name *

First Name Last Name
Date *

Month Day Year
PA driver's license # *
Phone number *

Area Code Phone Number
Pet's name or description of pet *
Email Address
Are you or your spouse currently employed? *

Yes No
Employer's Name *
Employer's Phone Number *

Area Code Phone Number
Home Information
Current Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Time at this Address *
Rent or Own? *

Rent Own
Home Owner Must Provide One of the Following: *
Landlord's Name *
Landlord's Phone Number *

Area Code Phone Number
How many people live in your home? *
Please list their name(s) and ages including yourself *
Does your home have a yard? *

Yes No
Is your yard fenced in? *

Yes No
Describe fence height/material: *
Traffic near home: *
Pet History
Do you currently own, or in the last five years have owned any pets? *

Yes No
Veterinarian's name: *
Veterinarian's phone number: *

Area Code Phone Number
Which pets do you own? *

One Dog One Cat Multiple Dogs Multiple Cats Other
Please specify: *
Are your pets spayed/neutered? *

Yes No
Have you adopted from a rescue organization before? *

Yes No
Which organization? *
Have you ever turned a pet over to a humane society/organization? *

Yes No
Please explain why: *
Adoption Information
Where will the pet spend it's days/nights? *
About how many hours per day will somebody be home? *
If your pet is not house broken, chews things up, etc., how do you plan to correct the behavior? *
Legal Information
Why are you interested in adopting a pet? *
Are you aware of any state laws pertaining to pet ownership/care? *

Yes No Somewhat
When is a good time for a home visit? (All members need to be present) *
References

Please do not use family members/relatives
Reference #1: *

First Name Last Name
Phone *

Area Code Phone Number
Reference #2 *

First Name Last Name
Phone *

Area Code Phone Number
All Finished!
By typing your full first and last name below, you are certifying that the above information is true and accurate to the best of your knowledge.
Full Name *

First Name Last Name
Should be Empty:

Adoption Application

General Information

Home Information

Pet History

Adoption Information

Legal Information

References

All Finished!